Plasma and red blood cell cholinesterase testing may be considered in cases in which organophosphorus compound co-exposure may have occurred or if offending toxicant has not been determined and the patient presents with signs or symptoms consistent with a cholinergic toxidrome.

Chest radiography may be indicated in the case of aspiration or acute lung injury. An abdominal radiograph may show evidence of radiopaque chlorinated pesticide.
[21] When the history of exposure is unclear, a head CT scan/lumbar puncture should be considered to rule out a central nervous system process or infection as a cause of seizures and altered mental status.

If necessary, gas chromatographic analytical studies of serum, adipose tissue, urine, and breast milk can be considered for documentation of exposure. For occupational purposes, performing adipose tissue biopsy testing for estimating total body burden of an exposed population is possible. This has no application in acute treatment of an individual exposed patient.

For the emergency department clinician, the above studies are unlikely to be of any acute clinical value because the likelihood of a rapid test result is small. However, obtaining samples for these examinations may be valuable for the extended-term evaluation and treatment of the patient.

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Postmortem Forensic Examination

In a postmortem forensic examination, brain analytical studies are warranted because severity of toxicity correlates with CNS concentration of these insecticides. Therefore, when a patient's death possibly is caused by acute or chronic pesticide exposure, alert the coroner so that appropriate safety issues may be addressed. This action is especially important in occupationally related cases.